What's the story on trepanation?

September 6, 2002

Dear Cecil:

You haven't had a really odd column in a while — how about an overview of trepanning? Who are some of the people availing themselves of this "earliest known surgery" and why are they allowed to run around loose (if in fact they are)? KIDS, DON'T TRY THIS AT HOME!

— hraka

Cecil replies:

Sound advice for troubled times, bub. Trepanning, also known as trephination, is the art of boring a hole in the skull for medical, mystical, or, God help us, recreational purposes. Practiced since the Stone Age (hence the "oldest known surgery" sobriquet), trepanning was common well into the 19th century, and a few iconoclasts are attempting to revive it today. One thinks with a shudder: Could this be the next goth fad?

Archaeological evidence of trepanning has turned up all over the world, in the form of skulls with holes bored into them up to two inches in diameter. Amazingly, say researchers, judging from signs of bone growth and the like, perhaps two-thirds of the patients survived. Maybe ancient trepannists were trying to relieve intracranial pressure due to disease, trauma, etc., in the manner of modern surgeons. Or maybe they just wanted to release the evil spirits. Nobody really knows.

Trepanning enjoyed a vogue centuries ago as a treatment for insanity, headaches, and other complaints. This was back in the era of leeching, mercury cures, and so on, when the line between health-care provider and murderer was less clear than it is now. The tools of the trade (see Trepanning.htm) consisted of (1) a sharp knife so you could slice the skin of the skull and pull back the flaps, (2) a corkscrewlike borer with a wicked-looking bit, and (3) files, brushes, and whatnot so you could dress up the job when done. In the old days trepanation was strictly a manual operation and took a long time. Today, with the advent of the electric drill (you think I'm joking?), an amateur can do it in an afternoon.

There are those who say trepanation has much to offer the modern world. You're saying: Come on, these people are psychos. I'm not arguing with you. However, being a psycho can take you a long way these days. Searching on trepanation in Google we come up with 6,120 hits. There's even a Web site sponsored by the International Trepanation Advocacy Group. OK, there's a Web site for everything. But skull boring has also been featured on network television, written up in the Washington Post (www.washingtonpost.com/wp-srv/style/features/trepan.htm) and the on-line journal Salon (http://www.salon.com/1999/04/29/trepanation/), even solemnly discussed at academic conferences ("International Colloquium on Cranial Trepanation in Human History," University of Birmingham, April 7-9, 2000). Perhaps I'm overstating the case here, but if you ask me, trepanation is hot.

I still don't think it's a good idea. You could, like, die, you know? Or get meningitis or suffer an accidental lobotomy. Some people who get trepanned, one has the feeling, didn't have a lot of spare gray matter to start with. A woman on the ITAG site says of her trepanned husband, "He does not appear to be so confused when more than one thing comes at him at once anymore." Listen, lady, one wants to have an open mind, as it were. But — you can see where I'm going with this — the average person needs trepanation like he needs a hole in the head.

The leading theorist of modern trepanation is Bart Huges, a Dutch research librarian who came up with a concept called "brainbloodvolume." Huges's idea is that when we're babies our skulls are soft (ever watch a newborn's forehead throb?), allowing our brains room to breathe and grow. But as we age our brains get locked in the old skullcase. Trepanation gives us back that lost freedom. Joe Mellen, an associate of Huges's, put the matter more succinctly in a book called Bore Hole: "This is the story of how I came to drill a hole in my skull to get permanently high."

Is trepanation the next big thing? Some indication may be gleaned from the career of Amanda Feilding of the UK, who in 1970 bored a hole in her skull with a dental drill after trying for four years to get a surgeon to do it. Feilding twice stood for Parliament on a pro-trepanation platform (she wanted it to be offered free by the National Health Service). The first time she got 49 votes, the second time 139. Sure, that's not many. But I don't like the trend.